Provider Demographics
NPI:1083600084
Name:ROSE, HENRY JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:JOHN
Last Name:ROSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:725 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4132
Mailing Address - Country:US
Mailing Address - Phone:413-447-2752
Mailing Address - Fax:413-496-6836
Practice Address - Street 1:777 NORTH ST
Practice Address - Street 2:RENAL DIALYSIS
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4147
Practice Address - Country:US
Practice Address - Phone:413-447-2764
Practice Address - Fax:413-447-2765
Is Sole Proprietor?:No
Enumeration Date:2005-09-25
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA57926207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology